内镜下乳头括约肌小切开后球囊扩张治疗巨大胆总管结石  

Efficiency and safety of limited endoscopic sphincterotomy plus endoscopic papillary balloon dilation in the treatment of giant choledocholithiasis

作　　者：陶涛[1] 张明 张启杰[1] 李明东[1] 李桂花[1] 朱萧 TAO Tao , ZHANG Ming, ZHANG Qi-jie, LI Ming-dong, LI Gui-hua, ZHU Xiao(Second Department of Gastroenterology, Central Hospital of Zibo, Zibo, Shandong 255000, China)

机构地区：[1]山东省淄博市中心医院消化内二科,山东淄博255000 [2]山东省淄博市中心医院康复科,山东淄博255000 [3]广东省医学分子诊断重点实验室,广东东莞523808

出　　处：《中国临床研究》2018年第9期1185-1189,共5页Chinese Journal of Clinical Research

基　　金：国家自然科学基金(81541153)

摘　　要：目的比较常规内镜下乳头括约肌切开术(EST)与内镜下乳头括约肌小切开术联合球囊扩张(ESBD)对巨大胆总管结石的治疗效果。方法自2012年1月至2013年6月将172例结石直径大于15 mm的胆总管结石病人随机分为常规EST组和ESBD组,每组86例。比较两种术式的结石清除率、内镜取石时间、机械碎石使用率及术后并发症情况。结果常规EST组结石完全清除率和一次性完全清除率分别为88. 4%和81. 4%,ESBD组为86. 0%和79. 1%,两组患者结石清除率无统计学差异(P=0. 648,P=0. 702)。常规EST组与ESBD组与手术时间分别为(38. 0±11. 0) min、(41. 0±14. 0) min,无统计学差异(P=0. 120)。常规EST组和ESBD组取石术中机械碎石使用率为分别为45. 1%和30. 7%(P=0. 034),术后并发症分别为11. 8%和8. 7%(P=0. 461),其中EST相关性出血、高淀粉酶血和急性胰腺炎并发症在两组间无明显差异(P=0. 205,P=0. 782,P=0. 627)。结论对于巨大胆总管结石,ESBD可以降低EST术中机械碎石使用率及术后出血的发生率,同时其取石成功率、手术取石时间与常规EST相比无明显差异,是一种安全有效的胆总管结石的内镜治疗方式。Objective To compare the clinical efficiency of endoscopic sphincterotomy（EST） and limited endoscopic sphincterotomy plus endoscopic papillary balloon dilation（ESBD） in the treatment of giant choledocholithiasis. Methods All the 172 patients with choledocholithiasis larger than 15 mm from January 2012 to June 2013 were divided into EST group and ESBD group randomly（n = 86 each）. The stone-free rate,time of endoscopic lithotripsy,rate of mechanical lithotripsy and postoperative complications were compared between two groups. Results Between EST group and ESBD group,there were no significant differences in total stone-free rate（88. 4% vs 86. 0%,P = 0. 648） and first-time stone-free rate（81. 4% vs 79. 1%,P = 0. 702）. There was no significant difference in operation time between EST group and ESBD group [（34. 0 ± 11. 0） min vs（41. 0 ± 14. 0） min,P = 0. 120]. The intra-operative mechanical lithotripsy rate in EST group was significant higher than that in ESBD group [45. 1%（46/102） vs 30. 7%（32/104）,P = 0. 034]. There was no significant difference between EST group and ESBD group in the total postoperative complication occurrence rate [11. 8%（12/102） vs 8. 7%（9/104）,P = 0. 461]. There were no significant differences in beleeding rate（P = 0. 205）,hyperamylasemia rate（P = 0. 782） and acute pancreatitis rate（P = 0. 627）. Conclusions ESBD is a safe and effective endoscopic treatment of giant choledocholithiasis,which could reduce the rate of mechanical lithotripsy. And the stone-free rate and operation time of ESBD are similar to those of EST.

关 键 词：内镜下乳头括约肌切开术 球囊扩张 机械碎石 胆总管结石 巨大结石 

分 类 号：R575.7[医药卫生—消化系统] R657.42[医药卫生—内科学]